Clinical Outcomes Associated With Various Microvascular Injury Patterns Identified by CMR After STEMI.
J Am Coll Cardiol
; 83(21): 2052-2062, 2024 May 28.
Article
in En
| MEDLINE
| ID: mdl-38777509
ABSTRACT
BACKGROUND:
The prognostic significance of various microvascular injury (MVI) patterns after ST-segment elevation myocardial infarction (STEMI) is not well known.OBJECTIVES:
This study sought to investigate the prognostic implications of different MVI patterns in STEMI patients.METHODS:
The authors analyzed 1,109 STEMI patients included in 3 prospective studies. Cardiac magnetic resonance (CMR) was performed 3 days (Q1-Q3 2-5 days) after percutaneous coronary intervention (PCI) and included late gadolinium enhancement imaging for microvascular obstruction (MVO) and T2∗ mapping for intramyocardial hemorrhage (IMH). Patients were categorized into those without MVI (MVO-/IMH-), those with MVO but no IMH (MVO+/IMH-), and those with IMH (IMH+).RESULTS:
MVI occurred in 633 (57%) patients, of whom 274 (25%) had an MVO+/IMH- pattern and 359 (32%) had an IMH+ pattern. Infarct size was larger and ejection fraction lower in IMH+ than in MVO+/IMH- and MVO-/IMH- (infarct size 27% vs 19% vs 18% [P < 0.001]; ejection fraction 45% vs 50% vs 54% [P < 0.001]). During a median follow-up of 12 months (Q1-Q3 12-35 months), a clinical outcome event occurred more frequently in IMH+ than in MVO+/IMH- and MVO-/IMH- subgroups (19.5% vs 3.6% vs 4.4%; P < 0.001). IMH+ was the sole independent MVI parameter predicting major adverse cardiovascular events (HR 3.88; 95% CI 1.93-7.80; P < 0.001).CONCLUSIONS:
MVI is associated with future adverse outcomes only in patients with a hemorrhagic phenotype (IMH+). Patients with only MVO (MVO+/IMH-) had a prognosis similar to patients without MVI (MVO-/IMH-). This highlights the independent prognostic importance of IMH in assessing and managing risk after STEMI.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Magnetic Resonance Imaging, Cine
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Percutaneous Coronary Intervention
/
ST Elevation Myocardial Infarction
Limits:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Language:
En
Journal:
J Am Coll Cardiol
Year:
2024
Type:
Article
Affiliation country:
Austria